Australian Society for HIV 2015

HIV and Hodgkin's lymphoma - a medical dilemma

The case is of a 30 year-old HIV positive Zimbabwean woman (UK resident) who arrived in Australia in January 2011 on a one-year working visa. She was diagnosed with HIV in 2003 in the UK and commenced on Atripla® in 2005. She was first seen in Adelaide in May 2011, requesting a script for Atripla.®.

An Indigenous cultural appropriateness audit piloted in a sexual health clinic in NSW: making Aboriginal and Torres Strait Islander peoples a priority.

Indigenous Australians experience a greater burden of sexually transmitted infections, however are less likely than the general population to access sexual health services. We examined the effectiveness of an Indigenous cultural appropriateness audit in assessing a sexual health clinic with low rates of Indigenous clients.

High Resolution Anoscopy - Practice makes perfect

Background: Liquid based anal Papanicolaou smears, followed by High Resolution Anoscopy (HRA) guided biopsies are increasingly being advocated to identify areas of High Grade Anal Intraepithelial Neoplasia (HGAIN). We hypothesized that the ability to identify HGAIN would increase with experience of the anoscopist, and that comparison with contemporary Papanicolaou smears might yield insights into technical abilities.

Chlamydia and the Urban Aboriginal Medical Service

Despite the high proportion of young people annually accessing general practices, including Aboriginal Medical Services (AMS), testing for Chlamydia trachomatis remains relatively low in urban areas. A project officer was employed within the Institute of Urban Indigenous Health (IUIH) to serve a mentoring and facilitation role for the SE Queensland network of AMS and their sexual health workers, with a view to improving testing, management and follow-up of chlamydia and other STIs by community controlled medical services.

An optimised eight-colour flow cytometry protocol for the analysis of monocyte heterogeneity and monocyte activation markers during HIV infection.

Monocytes are a heterogeneous cell population having specialised functions and differing phenotype. They are a link between innate immune system and adaptive immune system therefore, to identify if immune activation exists in HIV-1 individuals with controlled virema and recovered CD4 T cell counts, we assessed cell surface monocyte activation markers (MAM) within the monocyte subsets.

The Ask Share Know Project: a research translation study of three consumer questions to enhance treatment decision making

Involving consumers in healthcare decisions is important for high quality care. We previously tested a brief, consumer-led intervention consisting of three questions in a trial employing trained, standardized patients. The intervention enhanced discussion of evidence and increased patient involvement. We now report a research translation study which tested implementation with real patients at a reproductive and sexual health clinic.

Combination prevention with confidence?: A review of where community HIV health promotion evaluation is most, moderately and least developed

Protracted cryptococcal disease: immune reconstitution inflammatory syndrome (IRIS) or not?

Case presentation: A 27 year-old Vietnamese man was diagnosed with HIV in April 2012 when he presented with cerebrospinal fluid (CSF)-culture positive Cryptococcus neoformans meningitis. CD4 count was 4 cells/µL and HIV viral load 228827 copies/mL. He was treated with two weeks of amphotericin B (0.7mg/kg/day) and 5-fluorocytosine (25mg/kg/QID), followed by consolidation and secondary prophylaxis with fluconazole. CSF cultures were negative at two weeks. A ventriculo-peritoneal shunt was inserted to manage persistently raised intracranial pressure and had to be replaced two weeks later due to bacterial shunt infection. Antiretroviral therapy (ART) was commenced after four weeks of treatment, and by September 2012, CD4 count was 107 cells/L and viral load 150 copies/mL.

Prevalence and risk factors for high-grade squamous intraepithelial lesions (HSIL) in a community based cohort of homosexual men

Introduction: The incidence of human papillomavirus (HPV)-associated anal cancer is high in homosexual men, especially in the HIV-positive, but an understanding of the epidemiology of HSIL, the presumed precursor is lacking. We aimed to determine the prevalence and risk factors for HSIL in a community-recruited cohort of homosexual men.

Improving access to intrauterine device insertion in a single clinic visit - a pilot study

Family Planning NSW Hunter clinic is trialing a process aimed to improve service delivery of long-acting contraceptive methods. Traditionally, clients interested in an intra-uterine device (IUD) were required to attend an initial assessment visit prior to a second consultation for insertion of the device. Family Planning NSW Hunter is trialing a new process for providing IUD insertion in a single clinic visit, following completion of an on-line questionnaire.

Australian Society for HIV 2014

Immune Control of the HIV reservoirs

Prevalence of Sexually Transmitted Infections (STIs) and patient characteristics of older men over 60 years of age attending a public STD clinic in South Australia

Background: STI prevalence is changing. With society aging, life expectancy increasing and changes in sexual practices, STIs in senior citizens are of interest from economic, health related and social burden perspectives. Few studies on STIs in older men greater than 60 years of age exist, hence, a need to obtain further information about this subpopulation.

Conducting clinical audits to improve sexual health service delivery in primary health care services: Successes, challenges and lessons learnt

Conducting clinical audits in the context of continuous quality improvement (CQI) programs in Aboriginal Community Controlled Health Services (ACCHS) has provided valuable information regarding what factors facilitate or create challenges to improving outcomes in sexual health service delivery.

High prevalence, incidence and clearance of anal high-grade squamous intraepithelial lesions (HSIL) in homosexual men: early evidence from the Study of the Prevention of Anal Cancer (SPANC)

Homosexual men are at increased risk of anal cancer. Screening and treatment of the precursor, HSIL, has been advocated by some, but screening is not recommended in widely-accepted guidelines. We aimed to describe the prevalence, incidence, and clearance rates of anal HSIL, and association with human papillomavirus (HPV) status, in a community-recruited cohort of homosexual men.

HIV and syphilis co-infections and re-infections: trends from Victoria

Since 2009, the Victorian syphilis enhanced surveillance system has been collecting HIV status and syphilis re-infection status for infectious syphilis cases. Baseline data from 2009 showed that 31% of the infectious syphilis cases were HIV positive and 18% reported were re-infections. This suggested that syphilis transmission among a pool of HIV positive MSM was making a considerable contribution to the syphilis epidemic in Victoria. We analysed the data from 2009 to 2012 to determine whether this pattern of transmission is continuing. Notification data for infectious syphilis between 2009 and 2012 were reviewed by HIV infection status, syphilis re-infection status and risk factor exposures.

Efficacy and acceptability of a combination intervention for smoking cessation in HIV positive individuals: a pilot study

HIV positive gay men have high rates of cigarette smoking. The risks of smoking in addition to the elevated risk of cardiovascular disease and some malignancies in people with HIV means smoking cessation interventions should be prioritised.

Is the stage of the menstrual cycle related to chlamydia detection?

We investigated the association between chlamydia detection and stage in the menstrual cycle to investigate whether chlamydia detection was higher at different stages of the cycle. Electronic medical records for women attending Melbourne Sexual Health Centre March 2011 - 31st December 2012, who were tested for chlamydia by nucleic acid amplification of high vaginal, cervical, or urinary samples, and who recorded a date of last normal menstrual period (LNMP) between 0-28 days were included in the analysis. Logistic regression was used to calculate OR (95%CI) for the association of chlamydia with menstrual cycle adjusted by demographics and behavioural variables.

Unpacking Chlamydia in Victoria: Retrospective analysis of surveillance data to estimate reinfection

Chlamydia is prevalent among young Australians. The latest national surveillance report (2011) shows a rate of diagnosis of 1400 per 100,000 population aged 15-29 years. In Victoria, the number of notifications in 2011 was 19,238; 81% in 15-29 year olds; however notifications continue to rise in all age groups. International evidence suggests chlamydia reinfection is responsible for a substantial burden of infections. Given the associated health risks, monitoring reinfection in the population is important to understand disease burden and evaluate interventions. We describe the rate of reinfection and time between infections in Victoria, 2004-2011.

Online banner advertising: not the preferred medium for promoting a publicly funded sexual health clinic targeting men who have sex with men

Based on evidence of the success of utilising online campaigns to access MSM, RPA Sexual Health, a publically funded sexual health service (PFSHS) in the inner-west of Sydney, trialled two clinic advertising campaigns over a three year period. Both campaigns were developed with community consultation, targeting MSM and were predominantly online. They were evaluated and compared to measure their success and the effectiveness of advertising a PFSHS online.

The conscience clause in relation to termination of pregnancy service

Background: Medical termination of pregnancy (MTOP) has been available and successfully used as an option for women internationally since 1988. The regimen for MTOP results in abortion in 99% of cases. Since Mifepristone’s recent availability in Australia, Marie Stopes International has performed more than 10,000 MTOP procedures in Australia since 2009. In Victoria, the Law Reform Commission removed pregnancy termination (“abortion”) from the criminal statutes in August 2008, which provided women and health care professionals with protection from criminal prosecution for their legal involvement in termination of pregnancy (TOP).

Australian Society for HIV 2013

Delayed HIV diagnoses among gay and bisexual men in Australia

The majority of HIV diagnoses including delayed diagnoses in Australia occur among men who report homosexual contact – hereafter called gay and bisexual men (GBM). Delayed diagnosis is strongly associated with increased HIV-related mortality and morbidity. People who are unaware of their HIV-positive status may also be unwittingly transmitting HIV. We assessed trends in delayed HIV diagnoses among GBM in Australia.

Complex case report that illustrates the paucity of data for long term management of Visceral Leishmania-HIV co-infection.

HIV-associated leishmaniasis, endemic in the Mediterranean basin is a growing problem in India, Brazil and East Africa. Despite surviving for than 20 years, the clinical course of our visceral-leishmania (VL)-HIV co-infected patient illustrates several management challenges including diagnosis, speciation and drug resistance; monitoring burden of disease; access to and use of VL-treatments; end-organ toxicity and the combined immunosuppressive effects of HIV-VL.

Clinical factors associated with suboptimal adherence to antiretroviral therapy in Asia

Adherence to combination antiretroviral therapy (cART ) plays an important role on treatment outcomes. The TREAT Asia Studies to Evaluate Resistance – Monitoring Cohort Study (TASER-M) collects patients’ adherence based on a Visual Analogue Scale. The aim of this analysis was to assess the rates of, and factors associated with, suboptimal adherence in the first 24 months of initial cART in Asian patients.

Reinvigorating evidence for action and capacity in community HIV programs (REACH Project)

REACH was a collaborative research and practice initiative to develop evidence building frameworks, capacity, tools and resources with the Victorian HIV community partnership.

The impact of immune activation on natural killer cells in the setting of HIV infection

HIV disease is associated with chronic inflammation and activation of the innate immune system. This state, as measured using plasma markers of inflammation, persists following suppression of HIV viremia using antiretroviral therapy, and may increase risk of non-AIDS co-morbidities. The causes of innate immune activation in the setting of virological suppression are unclear. Natural killer (NK) cells are innate immune cells that kill virus-infected and transformed cells without prior sensitization. We have shown that NK cells are activated both phenotypically (elevated expression of HLA-DR) and functionally (increased spontaneous degranulation measured by CD107a surface expression) in virologically suppressed (VS) HIV+ individuals. NK cells also lose expression of CD16, the receptor which mediates antibody-dependent cellular cytotoxicity.

Men who take more risks avoid HIV testing due to structural barriers

Regular HIV testing is recommended in men who take sexual risks. We assessed the relationship between perceived barriers to HIV testing, and frequency of testing among men who engaged in unprotected anal intercourse with casual partners (UAIC), to inform HIV testing strategies.

Behavioural trends among Australian gay men pose increasing challenges for HIV prevention: findings from the Gay Community Periodic Surveys, 2003-1

Gay men remain the primary population affected by HIV in Australia. While recent attention has been focused on increasing HIV testing and the use of antiretroviral-based prevention to reduce infections, it is equally important to sustain safe sex and other risk reduction practices. Increases in unprotected anal intercourse (UAI), for example, may counteract any beneficial changes in testing and treatment. 

A dramatic increase in the use of mobile apps to meet partners among gay men in Melbourne and Sydney is not associated with increased risk-taking: findings from the Gay Community Periodic Surveys, 2010-2013

In recent years there has been a widespread uptake of smartphones with internet access and location services and the development of mobile ‘apps’ for gay men to meet each other. We reviewed data collected in the Sydney and Melbourne Gay Community Periodic Surveys (GCPS) to identify which men were relying on mobile and internet methods to meet each other and whether these methods were associated with different risk practices.

Breaking out: HIV treatment and care when PLWHIV transtition from custodial settings into the community

Background: People Living with HIV (PLHIV) who are transitioning from custodial settings are at risk of experiencing treatment interruptions and loss to follow up for vital HIV care. The NSW Persons In Custody HIV Community Referral Project (PICHCRP) aims to ensure PLHIV who are transitioning from custodial settings back into the community receive seamless HIV service, care and support.

Chlamydia prevalence in adolescent Australians

Most Australian guidelines for clinical screening of chlamydia infection advise testing sexually active individuals aged 16-24 years. Recent research shows that age at first sex in Australia is decreasing; a recent Victorian survey showed 29% of respondents reported being sexually active before age 16 years. There is also evidence that younger age at first sex is associated with risk behavior such as unprotected sex and having multiple sex partners.

International Society for Health and Human Rights 2011

War and trafficking: Supply and demand of trafficking.

In 2000, 120 nations took a stand against all forms of human trafficking through the Palermo Protocol to Prevent, Suppress and Punish Trafficking in Persons, especially Women and Children and encouraged

War and Trafficking: Migrant, trafficked and bonded workers and the business of organ harvesting.

The present-day abuses of migrant labour, human trafficking and bonded labour worldwide deserve long-overdue investigation by business academics into their causes and dynamics. Utilising data from

Group intervention with children

This article aims at reflecting, in the style of a story and not as a scientific or scholarly article, on a group therapy intervention with children of urban slums of Lima, populated by migrants from

The rise of juvenile crime in Georgia

Violence among the adolescents and adolescent delinquency often results in criminal charges and 14-18 year olds end up in the penitentiary facility. By the year 2005 only 26 adolescents were serving sentence in special juvenile facilities; however from 2006 onwards their number has increased drastically. At times the numbers of inmates reached 200, while today 162 juveniles are serving sentence. The rise of juvenile crime has become a debate issue for various groups of the Georgian society – education experts, psychologists, politicians are looking for the reasons of the situation at hand. We attempted a study of the demographic, social and academic profiles of adolescent inmates (the study of the Ministry of Education and Science, 2009), also taking into account our 5-year practice of working with juvenile convicts, which was aimed at supporting their resocialization and future reintegration into the society. In this work we will present a psychosocial portrait of an adolescent in the penitentiary system and consider the particular stress-factors that affect the juveniles and are determined by the specific features of the Georgian criminal subculture. We will also present 5 psychotypes of the adolescents in conflict with the law that were determined by the Freiburg personality test and will try to describe the self perception of the convicts while in confinement and after their sentence is served.

Stress factors in post-soviet period 1989-2011

The Collapse of the soviet system caused prolonged political, economical and psychosocial difficulties for the society. On one hand, collapse of totalitarian regime gives opportunity for change and

Research on trauma brought on by the disappearance of a child

Research on trauma brought on by the disappearance of a child is rare. The aim of our study was to increase understanding of uncertainty's role in the lives of those it affects, to present a narrative structure of the parents' testimonies, and to discern the origin of hope still felt by the parents. Sampling and Methods: Close reading and qualitative analysis of 29 testimonies given by parents whose sons disappeared during the Croatian War for Independence. Gender differences, categories, and frequencies of adjectives used were determined.

Case studies from GCRT of victims of war and other types of violence

During our work in GCRT for years we attained significant experience in psycho-traumatology. In contemporary concept of psycho-traumatology a human is referred to as a bio-psycho-social being. In trauma, its psychological and physical integrity are infringed. Person: soul and body is one whole, so it's very important to treat a person at every level through holistic and multidisciplinary approach. Our goal is to present cases of our beneficiaries, who were victims of war and other types of violence and developed different kind of psycho-traumatic disorders. We would like to share our experience of treating and rehabilitating body and psyche as one whole. Several cases (rehabilitation process and results) are discussed. In each presented case psycho-traumatic disorders have been diagnosed and confirmed clinically.

Justice and reparation: Acompanamiento a los afectados directos y sus faliliares

En esta coyuntura histórica de la realización de los Juicios a los responsables del Terrorismo de Estado de la última dictadura militar argentina, nos proponemos contribuir desde nuestro rol profesional en el acompañamiento a los afectados directos y sus familiares hoy constituidos en testigos y querellantes de estas causas. Desde una perspectiva psicosocial, la magnitud de los traumatismos producidos por la dictadura así como la impunidad posterior, ocasionaron daños profundos que persisten a lo largo del tiempo y a través de las generaciones. La realización de estos juicios, además de la oportunidad concreta de acceder a la condena de los responsables, permite la reelaboración personal y colectiva de lo ocurrido, así como habilita nuevos modelos de inscripción de la memoria histórica. Este escenario plantea nuevos desafíos que requieren complejos y particulares modos de intervención clínica y psicosocial. Se abordarán el dispositivo de acompañamiento psico-jurídico a testigos y querellantes como una de las intervenciones que desarrollamos en el ámbito de los derechos humanos y la salud mental, considerando el papel del testigo y del testimonio, sus aspectos reparatorios y de encuentro con lo traumático.

The recovery of mental health and human rights of victims of political violence in Peru and the work of CAPS

In 2002, during the so called Peruvian transition period (2001-2003), the Center for Psychosocial Care (CAPS) an NGO committed to the recovery of mental health and human rights of victims of political violence, acknowledged the need to formalize a program complementary to the integral psychosocial care that would allow victims of the conflict, could face economic hardship in which the civil war had left them. At that time, Peru had no institutional system to support victims of the conflict. However, after the mandate of the Commission of Truth and Reconciliation, civil society took in their hands this responsibility. CAPS through its program of social and humanitarian aid, intended to help victims not only focusing on counseling, psychotherapy, psychiatry and physical health problems but also offering loans that would allow them self-generating revenues through the implementation of a project that could be individual or collective.

Collective reparation and rehabilitation after torture.

The last years have seen a growing focus on international criminal justice, on victims’ rights to justice and on the right to reparation. Redress after gross human rights violations, such as torture, may include a number of different forms of reparation, such as symbolic measures, economic compensation, collective reparation and rehabilitation after torture. What do we know about all those around the world today that are presenting their cases, their experiences of loss, torture and ill-treatment before the courts, national or international ones? What are their experiences during the process and after? What do the results of the trial mean in their lives? These are some of the questions that will be raised in this presentation.

Attention Deficit Disorder

EEG Renaissance in Medicine and Neuroscience

In the 1990s Prof. Yuri Kropotov started his research in the field of quantitative EEG and evoked potentials in normal subjects, in ADHD population and in neurological patients to whom intracranial electrodes were implanted for diagnosis and therapy. 

Efficacy of neurofeedback treatment in ADHD: The effects on inattention, impulsivity and hyperactivity: A meta-analysis. (video link)

Since the first reports of neurofeedback treatment in ADHD in 1976 many studies have been carried out investigating the effects of neurofeedback on different symptoms of ADHD such as inattention, impulsivity and hyperactivity. This technique is also used by many practitioners, but the question as to the evidence-based level of this treatment is still unclear.

The need for more modeling and theory in EEG/qEEG

Phenotype evaluation of the EEG was proposed in a paper in 2005 published in Clinical Electroencephalography and Neurophysiology. The retrospective analysis of many decades of experience has since been actively evaluated, from published works focusing on basic neuroscience (J. Pop-Jordanov), and the work from Holland on medication response prediction (M. Arns).

DCS as a neuromodulatory approach to treating brain dysfunction

Professor Yuri Kropotov demonstrates that by knowing which brain dysfunction is associated with symptoms of ADHD a clinician can suggest the individualised treatment, whether it be medication, neurofeedback, tDCS or GABA agonists.

Jay Gunkelman in conversation with Dr Moshe Perl

What’s Hope got to do with it?- Coping, resilience and hope for mothers of a child with disability

This paper is an exploration of the theoretical grounds of resilience and hope. In our previous work with women who mother children with ADHD or ASD we found that many women are themselves disabled by their child's disability; they are isolateresild, marginalised and silenced (Carpenter & emerald 2009; Carpenter & Austin 2007). Yet, these women persevere in the face of the ongoing challenges of mothering a child with a disability. We now ask: is this resilience they show, or hope or is it something else again?

ADHD double blind placebo controlled neurofeedback studies

There has been an abundance of ADHD neurofeedback (NF) studies in the past decade in an effort to show NF’s efficacy on reducing the cardinal symptoms of ADHD. A recent meta-analysis concluded that NF was an efficacious treatment of ADHD, with a large effect size for inattention and impulsivity and a medium effect size for hyperactivity. Most studies, including the ones in the meta-analysis, have used a wait-list or active control as comparison groups. More recently, there have been a few NF studies using a blinded placebo-controlled design. These studies have shown equivocal results, indicating NF and placebo NF produced similar outcomes.

Changes in brain electrical activity of boys with ADHD following neurotherapy

This research is the first to demonstrate that Neurotherapy resulted in the dynamic neuromodulation of the dopamine-mediated frontal and norepinephrine-mediated parietal components of the attentional system, as proposed by Tucker and Williamson’s (1984) model of the attentional system. It provides further support to the recent controlled studies and meta-analysis that suggest that Neurotherapy is an effective and efficacious treatment for ADHD.

ADHD and Neurofeedback - latest efficacy research overview

Learning theory principles that contribute to details of application for the most effective neurofeedback training program will be presented. It has been established that many learning theory principles (classical conditioning, shaping, generalization, etc) are involved in the application known as neurofeedback. This talk is aimed to elaborate on the learning theory principles involved in the effective application of neurofeedback. Additionally, this talk provides the current evidence supporting the use of neurofeedback in the treatment of ADHD and recommendations on the implementation of neurofeedback in clinical practice.

Biological Underpinnings of ADHD, Depression and Anxiety.

This presentation address will relate research findings from various disciplines to help understand and identify the many possible causal factors for ADHD, Depression and Anxiety, hopefully leading

Health Promotion

Recovery through Community Conversations: a collaborative inter-sectoral approach.

Physical Activity for Health Among Torture and Trauma Survivors: an opportunity for treatment and prevention.

Sex (work) education.

Sex work plays a crucial educative capacity. Sex workers share tips and information on safer sex, sex and gender diversity, negotiation, boundaries and consent. We share these skills with other workers, clients, and the wider Australian community on a daily basis. In a range of capacities, sex work – including escorting, stripping, BDSM and pornography – involves interaction, transference of expertise, and sharing our voices. Sex work gives clients access to an important diversity of bodies, abilities, sexual practices, gender identities and intimacies.

The influence of the health promotion behaviours on the life satisfaction of the elderly with diabetes - a mediating effect of depression

With increasing elderly living with diabetes, health professionals have focused on the relations between behaviours improving health status and life satisfaction. This research attempts to explain the influence of the health promotion behaviours on the life satisfaction of the elderly with diabetes. Also, we are studying whether there is a mediating effect of depression between health promotion behaviours and life satisfaction of the elderly with diabetes. 685 persons with diabetes over 60 years of age were selected from the data of KLoSA (Korean Longitudinal Study of Ageing), administered by The National lnstitute of Labor in 2006. Life satisfaction was measured by 5 items: health status, economic status, relationship with a spouse, relationship with children, and the quality of life.

Men who take more risks avoid HIV testing due to structural barriers

Regular HIV testing is recommended in men who take sexual risks. We assessed the relationship between perceived barriers to HIV testing, and frequency of testing among men who engaged in unprotected anal intercourse with casual partners (UAIC), to inform HIV testing strategies.

Active recalling increases follow up attendance rates for men having sex with men (msm) prescribed non occupational post exposure prophylaxis (npep). A 2 ½ year prospective review.

Studies have shown that attendance rates of patients for review following NPEP, particularly at the three and six month intervals are not satisfactory. The follow-up of patients taking NPEP is important for the following reasons: 1. To increase compliance rates of NPEP regime completion 2. Ensure HIV seroconversion has not occurred 3. Allow regular STI screening in at risk patients 4. Reinforce education / behavioural counselling to decrease future high risk behaviours.

HIV diagnosed in Victoria among new migrants

As a proportion of the Victorian migrant population, Asian men and Sub-Saharan African women are disproportionately represented among notifications of newly diagnosed HIV in Victoria. This presents a variety of considerations for service provision including cultural barriers to health promotion, testing and treatment, especially for recent arrivals.

The Ask Share Know Project: a research translation study of three consumer questions to enhance treatment decision making

Involving consumers in healthcare decisions is important for high quality care. We previously tested a brief, consumer-led intervention consisting of three questions in a trial employing trained, standardized patients. The intervention enhanced discussion of evidence and increased patient involvement. We now report a research translation study which tested implementation with real patients at a reproductive and sexual health clinic.

Combination prevention with confidence?: A review of where community HIV health promotion evaluation is most, moderately and least developed

Be Clear About Sex!

Be clear about sex: the results of the sexual health lifestyle & co-creation campaign. On November 1, 2010, the youth campaign ‘Be clear about sex’ was started in the Netherlands. 17%


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